JMIR Publications

ABSTRACT

Background:

Nondaily smoking is an increasingly prevalent smoking pattern, which poses substantial health risks, and which disproportionally affects ethnic minorities and adults with a mental health or substance use problem.

Objective:

To test the feasibility of using a smartphone app with positive psychology exercises to support smoking cessation in nondaily smokers.

Methods:

Prospective, single-group, pilot study of nondaily smokers (n=30) who were prescribed Version 1 of the “Smiling Instead of Smoking” (SiS) app for three weeks while undergoing a quit attempt (1 week pre-, 2 weeks post-quit). The app assigned daily happiness exercises, provided smoking cessation tools, and made smoking cessation information available. Participants answered surveys at baseline and 2, 6, 12 and 24 weeks post-quit and participated in structured user feedback sessions two weeks after their chosen quit day. Feasibility was evaluated based on app usage, direct feedback via surveys and structured user feedback sessions, and by testing if theorized within-person changes were taking place.

Results:

App usage during the prescribed 3 weeks of use was high, with an average 84% of participants using the app on any given day. App use was largely driven by completing happiness exercises (73% of participants per day), which participants continued completing even after the end of the prescribed period. At the end of prescribed use, 90% of participants reported that the app had helped them during their quit attempt, primarily by reminding them to stay on track (83%) and boosting their confidence to quit (80%) and belief that quitting was worthwhile (80%). Happiness exercises were rated more favorably than user-initiated smoking cessation tools, and 80% of participants proactively expressed in interviews that they liked them. App functionality to engage social support was not well received. Functionality to deal with risky times was rated useful but was rarely used. Within-person changes from baseline to the end of prescribed use were observed for several theorized mechanisms of behavior change, all in the expected direction: confidence increased (internal cues: b=16.7 [95%CI: 7.2,26.3], p=.001; external cues: b=15.8 [95%CI: 5.4,26.1], p=.004), urge to smoke decreased (b=-0.8 [95%CI: -1.3,-0.3], p=.002), and perceptions of smoking became less positive (psychoactive benefits: b=-0.5 [95%CI: -0.9,-0.2], p=0.006; pleasure: b=-0.4 [95%CI: -0.7, -0.01], p=.03; importance of pros of smoking: b=-11.3 [95%CI: -18.9, -3.8], p=.004). Self-reported abstinence rates were 40% and 55% of participants 2 and 24 weeks post-quit, respectively, with 27% biochemically validated as abstinent 2 weeks post-quit.

Conclusions:

A smartphone app using positive psychology exercises to aid smoking cessation was well received by nondaily smokers. Given high nonadherence and dropout rates for technology-delivered interventions reported in the literature, the high engagement with positive psychology exercises is noteworthy. Observed within-person changes and abstinence rates are promising, and warrant further development of this app.